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Meta-Analysis
. 2009 Jan 21;2009(1):CD006761.
doi: 10.1002/14651858.CD006761.pub2.

Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids

Simon Nienhuijs  1 , Ignace de Hingh
Affiliations
Meta-Analysis

Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids

Simon Nienhuijs et al. Cochrane Database Syst Rev. .

Abstract

Background: Hemorrhoidectomy is a frequently performed surgical procedure and associated with postprocedural pain. The use of the Ligasure could result in a decreased incidence of pain as coagulation with high frequency currency and active feedback control over the power output has minimal thermal spread and limited tissue charring.

Objectives: To compare patient tolerance focussing on pain following Ligasure and conventional hemorrhoidectomy in patients with symptomatic hemorrhoids.

Search strategy: A multi-database (MEDLINE, EMBASE, CENTRAL and CINAHL) systematic search was conducted. Key journals were handsearched. There was no restriction on language.

Selection criteria: Randomized controlled trials comparing hemorroidectomy using the Ligasure-technique with conventional diathermy techniques for symptomatic hemorrhoids in adult patients were included.

Data collection and analysis: Two reviewers independently extracted data, assessed trial quality and resolved discrepancies together with a third party. Odd Ratios were generated for dichotomous variables. Weight Mean Differences were used for analysing continuous variables. Only random effects models were used. Heterogeneity was explored by sensitvity analysis.

Main results: Twelve studies with 1142 patients met the inclusion criteria. The pain score at the first day following surgery was significantly less in the Ligasure group (10 studies, 835 patients, WMD -2.07 CI -2.77 to -1.38). Most outcomes concerning analgesics used (7 studies) and pain scores up to 7 days (5 studies) favoured the Ligasure-technique. The benefit was diminished at day 14 (VAS pain score, 4 studies, 183 patients, WMD -0.12 CI -0.37 to 0.12). The conventional technique took significantly longer to complete (11 trials, 9.15 minutes, CI 3.21 to 15.09). There was no relevant difference in postoperative complications, symptoms of recurrent bleeding or incontinence at final follow-up. Hospital stay was similar for both groups (6 reports, 525 patients, WMD -0.19 CI -0.63 to 0.24). Patients treated with the Ligasure-technique returned to work significantly earlier (4 studies, 451 patients, 4.88 days, CI 2.18 to 7.59). Sensitivity analysis on high quality studies, fixed effects models, open or closed conventional techniques revealed no clinical relevant different results.

Authors' conclusions: Since the usage of the Ligasure technique results in significantly less immediate postoperative pain after hemoroidectomy without any adverse effect on postoperative complications, convalescence and incontinence-rate, this technique is superior in terms of patient tolerance. Although there was a tendency for equal efficacy, more evaluation of the long-term risk of recurrent hemorrhoidal disease is required.

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Conflict of interest statement

None known.

S O U R C E S O F S U P P O R T External sources of support • No sources of support supplied Internal sources of support • No sources of support supplied

Figures

1.1
1.1. Analysis
Comparison 1 Pain, Outcome 1 Pain score at day 1.
1.2
1.2. Analysis
Comparison 1 Pain, Outcome 2 Pain score at day 7.
1.3
1.3. Analysis
Comparison 1 Pain, Outcome 3 Pain score at day 14.
1.4
1.4. Analysis
Comparison 1 Pain, Outcome 4 Daily pain score first 7 days.
1.5
1.5. Analysis
Comparison 1 Pain, Outcome 5 Pain score at first defecation.
1.6
1.6. Analysis
Comparison 1 Pain, Outcome 6 Amount of pethidine (in mg) used.
1.7
1.7. Analysis
Comparison 1 Pain, Outcome 7 Amount of tramadol (in g) used / week.
1.8
1.8. Analysis
Comparison 1 Pain, Outcome 8 Number of ketoprofen (50 mg) used / week.
1.9
1.9. Analysis
Comparison 1 Pain, Outcome 9 Number of dipyrone (250 mg) used.
1.10
1.10. Analysis
Comparison 1 Pain, Outcome 10 Number of diclofenac (75 mg) used first 24 hours.
1.11
1.11. Analysis
Comparison 1 Pain, Outcome 11 Number of patients using additional parenteral analgesics.
2.1
2.1. Analysis
Comparison 2 Procedure, Outcome 1 Operating time in minutes.
2.2
2.2. Analysis
Comparison 2 Procedure, Outcome 2 Intraoperative blood loss in mililitres.
3.1
3.1. Analysis
Comparison 3 Complications, Outcome 1 Postoperative bleeding.
3.2
3.2. Analysis
Comparison 3 Complications, Outcome 2 Urinary retention.
3.3
3.3. Analysis
Comparison 3 Complications, Outcome 3 Constipation.
3.4
3.4. Analysis
Comparison 3 Complications, Outcome 4 Wound dehiscence in days.
3.5
3.5. Analysis
Comparison 3 Complications, Outcome 5 Wound swelling at day 7.
3.6
3.6. Analysis
Comparison 3 Complications, Outcome 6 Incomplete healing at day 14.
3.7
3.7. Analysis
Comparison 3 Complications, Outcome 7 Incomplete healing at day 21.
3.8
3.8. Analysis
Comparison 3 Complications, Outcome 8 Incomplete healing at day 28.
3.9
3.9. Analysis
Comparison 3 Complications, Outcome 9 Incomplete healing at day 42.
3.10
3.10. Analysis
Comparison 3 Complications, Outcome 10 Anal fissure.
3.11
3.11. Analysis
Comparison 3 Complications, Outcome 11 Anal stenosis.
3.12
3.12. Analysis
Comparison 3 Complications, Outcome 12 Late minor bleeding.
4.1
4.1. Analysis
Comparison 4 Incontinence, Outcome 1 Symptoms of incontinence at follow‐up.
4.2
4.2. Analysis
Comparison 4 Incontinence, Outcome 2 Incontinence score at follow‐up.
5.1
5.1. Analysis
Comparison 5 Convalescence, Outcome 1 Hospital stay in days.
5.2
5.2. Analysis
Comparison 5 Convalescence, Outcome 2 Return to work in days.
5.3
5.3. Analysis
Comparison 5 Convalescence, Outcome 3 Number of patients unhappy with results.
6.1
6.1. Analysis
Comparison 6 Sensitivity analysis no.1, Outcome 1 MJS>3; Pain score at day 1.
6.2
6.2. Analysis
Comparison 6 Sensitivity analysis no.1, Outcome 2 MJS>3; Postoperative bleeding.
6.3
6.3. Analysis
Comparison 6 Sensitivity analysis no.1, Outcome 3 MJS>3; Urinary retention.
6.4
6.4. Analysis
Comparison 6 Sensitivity analysis no.1, Outcome 4 MJS>3; Anal stenosis.
6.5
6.5. Analysis
Comparison 6 Sensitivity analysis no.1, Outcome 5 MJS>3; Symptoms of incontinence at follow‐up.
6.6
6.6. Analysis
Comparison 6 Sensitivity analysis no.1, Outcome 6 MJS>3; Hospital stay in days.
7.1
7.1. Analysis
Comparison 7 Sensitivity analysis no.2, Outcome 1 FIXED; Pain score at day 1.
7.2
7.2. Analysis
Comparison 7 Sensitivity analysis no.2, Outcome 2 FIXED; Postoperative bleeding.
7.3
7.3. Analysis
Comparison 7 Sensitivity analysis no.2, Outcome 3 FIXED; Urinary retention.
7.4
7.4. Analysis
Comparison 7 Sensitivity analysis no.2, Outcome 4 FIXED; Anal stenosis.
7.5
7.5. Analysis
Comparison 7 Sensitivity analysis no.2, Outcome 5 FIXED; Symptoms of incontinence at follow‐up.
7.6
7.6. Analysis
Comparison 7 Sensitivity analysis no.2, Outcome 6 FIXED; Hospital stay in days.
8.1
8.1. Analysis
Comparison 8 Sensitivity analysis no.3, Outcome 1 OPEN; Pain score at day 1.
8.2
8.2. Analysis
Comparison 8 Sensitivity analysis no.3, Outcome 2 OPEN; Postoperative bleeding.
8.3
8.3. Analysis
Comparison 8 Sensitivity analysis no.3, Outcome 3 OPEN; Urinary retention.
8.4
8.4. Analysis
Comparison 8 Sensitivity analysis no.3, Outcome 4 OPEN; Anal stenosis.
8.5
8.5. Analysis
Comparison 8 Sensitivity analysis no.3, Outcome 5 OPEN; Symptoms of incontinence at follow‐up.
8.6
8.6. Analysis
Comparison 8 Sensitivity analysis no.3, Outcome 6 OPEN; Hospital stay in days.
9.1
9.1. Analysis
Comparison 9 Sensitivity analysis no.4, Outcome 1 CLOSED; Pain score at day 1.
9.2
9.2. Analysis
Comparison 9 Sensitivity analysis no.4, Outcome 2 CLOSED; Postoperative bleeding.
9.3
9.3. Analysis
Comparison 9 Sensitivity analysis no.4, Outcome 3 CLOSED; Urinary retention.
9.4
9.4. Analysis
Comparison 9 Sensitivity analysis no.4, Outcome 4 CLOSED; Anal stenosis.
9.5
9.5. Analysis
Comparison 9 Sensitivity analysis no.4, Outcome 5 CLOSED; Symptoms of incontinence at follow‐up.
9.6
9.6. Analysis
Comparison 9 Sensitivity analysis no.4, Outcome 6 CLOSED; Hospital stay in days.
See this image and copyright information in PMC

Update of

References

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